An Examination of Applicants and Factors Associated with Matriculation to Complex General Surgical Oncology Fellowship Training Programs

Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study

BACKGROUND

Surgical subspecialty training aims to meet the needs of practicing surgeons and their communities. This study investigates career preparedness of Complex General Surgical Oncology (CGSO) fellowship graduates, identifies factors associated with practice readiness, and explores potential opportunities to improve the current training model.

METHODS

The Society of Surgical Oncology partnered with the National Cancer Institute to conduct a 36-question survey of CGSO fellowship graduates from 2012 to 2022.

RESULTS

The overall survey response rate was 38% (221/582) with a slight male predominance (63%). Forty-six percent of respondents completed their fellowship after 2019. Factors influencing fellowship program selection include breadth of cancer case exposure (82%), mentor influence (66%), and research opportunities (38%). Overall, graduates reported preparedness for practice; however, some reported unpreparedness in research (18%) and in specific clinical areas: thoracic (43%), hyperthermic intraperitoneal chemotherapy (HIPEC) (15%), and hepato-pancreato-biliary (15%) surgery. Regarding technical preparedness, 70% reported being "very prepared". Respondents indicated lack of preparedness in robotic (63%) and laparoscopic (33%) surgery approaches. Suggestions for training improvement included increased autonomy and case volumes, program development, and research infrastructure. Current practice patterns by graduates demonstrated discrepancies between ideal contracts and actual practice breakdowns, particularly related to the practice of general surgery.

CONCLUSIONS

This study of CGSO fellowship graduates demonstrates potential gaps between trainee expectations and the realities of surgical oncology practice. Although CGSO fellowship appears to prepare surgeons for careers in surgical oncology, there may be opportunities to refine the training model to better align with the needs of practicing surgical oncologists.

Financial Barriers to Surgical Conferences: A Cross-Sectional Analysis of Registration Fees

BACKGROUND

Scientific meetings provide much educational value to participants of all career stages. There is a paucity of literature surrounding the costs of attending scientific meetings and how this may affect participation, especially among trainees. The objective of this study is to assess the accessibility of surgical conferences for attendees by analyzing costs related to surgical society membership and conference registration.

METHODS

Societal membership and conference registration fee data were collected according to career stage (i.e., student, resident, fellow, and staff) for the fourteen surgical specialties recognized by the American College of Surgeons (ACS). Fees for participants from low- and middle-income countries (LMICs) and for virtual-only attendance options were also collected when available.

RESULTS

Overall, we included data from 46 surgical societies (32 North American, 14 European or global). The median conference fees for students in the member and non-member categories were 191.55 USD (IQR 42.22-320.99) and 452.40 USD (IQR 294.06-555.00), respectively, representing a 136.2% price increase if not a member. Median conference fees for residents, fellows, and staff in the member category were 65.5%, 66.9%, and 230.9% greater than that for students, respectively. Median prices for residents, fellows, and staff in the non-member category were 49.9%, 54.9%, and 49.9% greater than that for member trainees of the same category, respectively.

CONCLUSIONS

Our results highlight the substantial costs associated with attending surgical conferences, especially for trainees, representing a significant barrier to already financially burdened trainees, especially those from LMICs, smaller institutions, or less well-off backgrounds.

An Original Study: Is There an Optimal Time to Complete Dedicated Research During Surgical Residency? Twelve Years of Research Experience After PGY2 or PGY3

OBJECTIVE

We aimed to determine if there is an optimal time to complete dedicated research during surgical residency.

BACKGROUND

Research is an integral part of academic general surgical residency, and dedicated research usually occurs after the 2nd or 3rd post-graduate year (PGY). The timing of dedicated research and its association with resident productivity, self-assessed competency (including technical skills), and fellowship match is not known.

METHODS

PubMed was queried for publications resulting after dedicated research time for graduating surgical residents at a single institution from 2010 to 2021. Graduates were surveyed about their research experience and placed into 2 groups: research after PGY2 or PGY3.

RESULTS

Sixty-six of 91 (73%) graduating residents completed dedicated research (after PGY2, n=28; after PGY3, n=38). Median number of total and first author publications was similar between groups; however, research after PGY2 was associated with an increased number of basic science publications by fellowship application deadlines (PGY2: 1.0[0-13] vs PGY3: 0.0[0-6], p=0.02). With a 79% survey response rate, there were no differences in self-assessed competencies upon return from research between cohorts. Most surveyed residents matched at their top fellowship choice (PGY2:70% vs PGY3:62%, p=0.77).

CONCLUSIONS

Research after PGY2 or PGY3 had no association with residents' total number of publications, self-assessed competency, or rates of matching at first choice fellowship. As research after PGY2 had an increased number of basic science publications by time of fellowship application, surgical residents applying to fellowships that highly value basic science research may benefit from completing dedicated research after PGY2.

Are Orthopedic Fellowship Programs Giving Out Too Many Interviews? A Retrospective Analysis Suggests They Are

Background: The orthopedic surgery fellowship match process is associated with substantial stress and expense, yet the optimal number of interviews for fellowships to offer has not been evaluated. Purpose: We sought to evaluate the number of orthopedic surgery fellowship interviews given and construct a model to determine the appropriate number of interviews to offer based on specialty and program size. Methods: We conducted a retrospective study of 6 orthopedic fellowship specialties; data were obtained from San Francisco Match and covered the 5-year period from 2014 to 2018. The orthopedic fellowship subspecialties included adult reconstruction/oncology, foot and ankle, pediatrics, spine, sports medicine, and trauma. We excluded shoulder and elbow (less than 5 years of data) and hand and upper extremity (alternative matching process). Parameters included number of programs, number of spots per program, number of ranked applicants per program (mean ± SD), and difference in number of interviews offered and ranked applicants per program (mean ± SD). Multiple regression analysis was used to create an equation for determining the optimal number of interviews for the programs. Results: Of 1377 orthopedic fellowship programs analyzed, 1370 (99.50%) conducted interviews beyond the number of ranked applicants. Programs ranked an overall mean of 20.10 ± 10.17 applicants with an overall mean of 11.60 ± 8.62 additional interviews offered. Sports medicine had the highest mean ranked applicants (23.21 ± 9.77) and pediatrics had the lowest mean ranked applicants (15.74 ± 7.76). The most additional interviews were given in adult reconstruction (14.80 ± 9.92) and the least were given in pediatrics (8.32 ± 7.17). The predictive equation was reported as Y = β1x1 + β2x2 (Y = ranked applicants, x1 = spots open, and x2 = last rank). Conclusion: Programs in 6 orthopedic subspecialties in the fellowship match process appear to consistently offer more interviews than necessary. We have developed a model to help programs predict the optimal number of fellowship applicants to interview. Future studies need to validate the model, especially with anticipated increases of the virtual interview format.

Fellowship Training in Oral and Maxillofacial Surgery: Opportunities and Outcomes

The pursuit of fellowship training stems from one's desire to master a focused area of surgery. Successful applicants tend to have published articles and participated in other scholarly activities. They commonly have a mentor within the subspecialty of their interest. Selection of the program is generally based on the breadth of experience available followed by faculty reputation and location. Advantages to the successful fellowship graduate include the experience and confidence to provide specialized and efficient care to patients. Enhancements to an academic department with a fellowship program include mentorship for residents and guidance toward fellowship, as well as an increased level of scholarly activity.

Application and Match Rates in the Complex General Surgical Oncology Match

Background

The Society of Surgical Oncology collaborates with the National Resident Matching Program (NRMP) to facilitate the Complex General Surgical Oncology (CGSO) Match.

Objective

The purpose of this study was to understand trends in CGSO Match outcomes. We hypothesized that (1) match rates would increase with time; (2) US allopathic graduates would have higher match rates than non-US allopathic graduates; and (3) most applicants would match at one of their top three ranked choices.

Methods

The NRMP provided applicant and program data from the CGSO Match (2014–2021). Chi-square tests elucidated temporal trends and match rates by applicant archetype.

Results

The annual number of applicants decreased from 103 to 90 (13% decrease), while the annual number of fellowship positions increased from 56 to 67 (20% increase) from 2014–2021. The annual percentage of applicants who did not match decreased from 46% to 26% (p < 0.05). Annual match rates increased from 54% to 74% (p < 0.05). US allopathic graduates had higher match rates than non-US allopathic graduates but this disparity narrowed over time (84% vs. 55% in 2021; p < 0.001). Approximately half of all applicants matched at one of their top three choices (first, 29%; second, 12%; third, 8%). Applicants matching at one of their top three choices increased from 36% to 50% (p < 0.05).

Conclusions

CGSO Match rates have increased over the past decade, thus primarily benefiting non-US allopathic graduates. Most applicants match at one of their top three choices. More research is needed to understand disparities in match rates by applicant and residency program characteristics.

Recent Changes in Characteristics of Applicants and Matriculants to Thoracic Surgery Fellowships

The match rate for traditional thoracic surgery fellowships decreased from 97.5% in 2012 to 59.1% in 2021, reflecting an increase in applications. We queried whether characteristics of applicants and matriculants to traditional thoracic surgery fellowships changed during this time period. Applicant data from the 2008 through 2018 application cycles were extracted from the Electronic Residency Application System (ERAS) and Graduate Medical Education (GME) Track Resident Survey and stratified by period of application (2008-2014 vs 2015-2018). Characteristics of applicants and matriculants were analyzed. There were 697 applicant records in the early period and 530 in the recent period (application rate 99.6/year vs 132.5/year; P = 0.0005), and 607 matriculant records in the early period and 383 in the recent period (matriculation rate 87% vs 72%; P < 0.0001). There was no difference in representation of university-affiliated versus community-based general surgery residency programs among applicants comparing the periods. Higher proportions of applicants and matriculants in the early period trained in general surgery programs affiliated with a comprehensive cancer center or a thoracic surgery fellowship. Applicants and matriculants of the recent period had higher median numbers of journal publications and had higher impact factor journal publications. The increase in applicants for thoracic surgery training is primarily from general surgery trainees in residency programs not affiliated with a comprehensive cancer center or a thoracic surgery fellowship. The increased interest in thoracic surgery training was accompanied by overall enhanced scholarship production among the applicants and matriculants regardless of their residency characteristics.

Characteristics of Matriculants to Thoracic Surgery Residency Training Programs

BACKGROUND

Thoracic surgery (TS) residency positions are in high demand. There is no study describing the nationwide attributes of successful matriculants in this specialty. We examined the characteristics of TS resident applicants and identified factors associated with acceptance.

METHODS

Applicant data from 2014 to 2017 application cycles was extracted from the Electronic Residency Application System and stratified by matriculation status. Medical education, type of general surgery residency, and research achievements were analyzed. The number of peer-reviewed publications and the corresponding impact factor for the journals where they were published were quantified.

RESULTS

There were 492 applicants and 358 matriculants. The overall population was primarily male (79.5%), white (55.1%), educated at United States allopathic medical schools (66.5%), and trained at university-based general surgery residencies (59.6%). Education at United States allopathic schools (odds ratio [OR], 2.54; P < .0001), being a member of the American Osteopathic Association (OR, 3.27; P = .021), general surgery residency affiliation with a TS residency (OR, 2.41; P = .0003) or National Cancer Institute designated Comprehensive Cancer Center (OR, 1.76; P = .0172), and being a first-time applicant (OR, 4.71, P < .0001) were independently associated with matriculation. Matriculants published a higher number of manuscripts than nonmatriculants (median of 3 vs 2, P < .0001) and more frequently published in higher impact journals (P < .0001).

CONCLUSIONS

Our study includes objective and quantifiable data from recent application cycles and represents an in-depth examination of applicants to TS residency. The type of medical school and residency, as well as academic productivity, correlate with successful matriculation.

Publication Trends and Their Relationship With Academic Success Among Dermatology Residents: Cross-sectional Analysis

BACKGROUND

Involvement in scholarly activities is considered to be one of the foundational pillars of medical education.

OBJECTIVE

This study aims to investigate publication rates before, during, and after residency to determine whether research productivity throughout medical training correlates with future academic success and research involvement.

METHODS

We successfully identified a list of 296 graduates from 25 US dermatology residency programs from the years 2013-2015. The publication history for each graduate was compiled using Scopus, PubMed, and Google Scholar. The Pearson correlation test and linear regression were used to assess the relationship between research productivity and continued academic success after residency graduation.

RESULTS

Before residency, graduates published a mean of 1.9 (SD 3.5) total publications and a mean of 0.88 (SD 1.5) first-author publications. During residency, graduates published a mean of 2.7 (SD 3.6) total publications and a mean of 1.39 (SD 2.0) first-author publications. Graduates who pursued a fellowship had more total publications (t294=-4.0; P<.001), more first-author publications (t294=-3.9; P<.001), and a higher h-index (t294=-3.8; P=.002). Graduates who chose to pursue careers in academic medicine had more mean total publications (t294=-7.5; P<.001), more first-author publications (t294=-5.9; P<.001), and a higher mean h-index (t294=-6.9; P<.001). Graduates with one or more first-author publications before residency were 1.3 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.3, 95% CI 1.1-1.5). Graduates who pursued a fellowship were also 1.9 times more likely to pursue a career in academic medicine (adjusted odds ratio 1.9, 95% CI 1.2-3.2).

CONCLUSIONS

Our results suggest that research productivity before and during residency training are potential markers for continued academic success and research involvement after completing dermatology residency training.

Evaluation of Factors Associated With Successful Matriculation to Colon and Rectal Surgery Fellowship

BACKGROUND

As an increasing number of general surgery residents apply for fellowship positions, it is important to identify factors associated with successful matriculation. For applicants to colon and rectal surgery, there are currently no objective data available to distinguish which applicant attributes lead to successful matriculation.

OBJECTIVE

The purpose of this study was to identify objective factors that differentiate colon and rectal surgery fellowship applicants who successfully matriculate with those who apply but do not matriculate.

DESIGN

This was a retrospective analysis of colon and rectal surgery applicant characteristics.

SETTINGS

Deidentified applicant data provided by the Association of American Medical Colleges from 2015 to 2017 were included.

MAIN OUTCOME MEASURES

Applicant demographics, medical school and residency factors, number of program applications, number of publications, and journal impact factors were analyzed to determine associations with successful matriculation.

RESULTS

Most applicants (n = 371) and subsequent matriculants (n = 248) were white (61%, 62%), male (65%, 63%), US citizens (80%, 88%) who graduated from US allopathic medical schools (66%, 75%). Statistically significant associations included graduation from US allopathic medical schools (p < 0.0001), US citizenship (p < 0.0001), and number of program applications (p = 0.0004). Other factors analyzed included American Osteopathic Association membership (p = 0.57), university-based residency (p = 0.51), and residency association with a colon and rectal surgery training program (p = 0.89). Number of publications and journal impact factors were not statistically different between cohorts (p = 0.067, p = 0.150).

LIMITATIONS

American Board of Surgery In-Training Examination scores, rank list, and subjective characteristics, such as strength of interview and letters of recommendation, were not available using our data source.

CONCLUSIONS

Successful matriculation to a colon and rectal surgery fellowship program was found to be associated with US citizenship, graduation from a US allopathic medical school, and greater number of program applications. The remaining objective metrics analyzed were not associated with successful matriculation. Subjective and objective factors that were unable to be measured by this study are likely to play a determining role. See Video Abstract at http://links.lww.com/DCR/B415.

EVALUACIN DE FACTORES VINCULADOS EN LA INMATRICULACIN EXITOSA PARA BECAS DE CIRUGA COLORRECTAL

ANTECEDENTES:A medida que un número cada vez mayor de residentes de Cirugía General solicitan una beca, es importante identificar los factores vinculados con una inmatriculación exitosa. Para los candidatos a una beca en Cirugía Colorrectal, hoy en día no existen datos objetivos disponibles para distinguir qué atributos del solicitante conducen a una inmatriculación exitosa.OBJETIVO:Identificar objetivamente los factores que diferencian un candidato a una beca en Cirugía Colorrectal que se inmatricula con éxito de aquel que aplica pero no llega a inmatricularse.DISEÑO:Análisis retrospectivo de las características de los solicitantes de beca para Cirugía Colorrecatl.AJUSTES:Datos de los solicitantes no identificados, proporcionados por la Asociación de Colegios Médicos Estadounidenses de 2015 a 2017.PRINCIPALES MEDIDAS DE RESULTADO:Se analizaron los factores demográficos del solicitante, las facultades de medicina y los factores de la residencia, el número de solicitudes de programas, el número y el factor de impacto de las publicaciones realizadas para determinar la asociación con una inmatriculación exitosa.RESULTADOS:La mayoría de los solicitantes (n = 371) que posteriormente fueron inmatriculados exitosamente (n = 248) eran blancos (61%, 62%, respectivamente), hombres (65%, 63%), ciudadanos estadounidenses (80%, 88%) que se graduaron de Facultades de medicina alopática en los EE. UU. (66%, 75%). Las asociaciones estadísticamente significativas incluyeron la graduación de las escuelas de medicina alopática de los EE. UU. (P <0,0001), la ciudadanía de los EE. UU. (P <0,0001) y el número de solicitudes de programas (p = 0,0004). Otros factores analizados incluyeron: membresía AOA (p = 0,57), la residencia universitaria (p = 0,51) y asociación de la residencia con un programa de formación en Cirugía Colorrectal (p = 0,89). El número de publicaciones y los factores de impacto de las revistas no fueron estadísticamente diferentes entre las cohortes (p = 0,067, p = 0,15, respectivamente).LIMITACIONES:El Score ABSITE, la posición en lista de clasificación y las características subjetivas como el de una buena entrevista y las cartas de recomendación no se encontraban disponibles en la fuente de datos.CONCLUSIONES:Se encontró que la inmatriculación exitosa a un programa de becas de Cirugía Colorreectal estaba asociada con la ciudadanía estadounidense, la graduación en una Facultad de medicina alopática en los EE. UU, y al mayor número de solicitudes de programas. El analisis de las medidas objetivas restantes no se asociaron con una inmatriculación exitosa. Es probable que los factores subjetivos y objetivos que no pudieron ser medidos por este estudio jueguen un papel determinante. Consulte Video Resumen en http://links.lww.com/DCR/B415. (Traducción-Dr Xavier Delgadillo).

Qualities and characteristics of applicants associated with successful matriculation to pediatric surgery fellowship training

BACKGROUND

Pediatric surgery (PS) is among the most competitive fellowship opportunities for general surgery residents. Prior investigations into factors associated with successful matriculation to PS have relied on surveys, which have inherent biases.

STUDY DESIGN

Data were extracted from the Electronic Residency Application System for applicants from 2012 to 2017 and analyzed after stratification by matriculation status.

RESULTS

Data were gathered on a total of 444 applicants, of which 238 matriculated. The applicant pool was predominantly Caucasian (63.5%), largely graduated from US allopathic school (81%) and had a slight male predominance (54%), although the number of female applicants increased significantly over the study period. Attendance at a US allopathic medical school (OR=4.55, p <0.001), university-based general surgery training (OR=3.02, p <0.001) and training at institutions that offer PS fellowships (OR=3.36, p<0.001) were associated with matriculation. Matriculants had a higher quantity of peer reviewed publications (median 11 vs. 6, p <0.001) and published in high impact factor journals (p<0.001). A total of 65 applicants reapplied at least once, of whom 32% successfully matriculated.

CONCLUSIONS

PS applicants' medical school, residency, and research data points correlated with successful matriculation. These data may help guide general surgery residents and medical students aspiring to become pediatric surgeons.

TYPE OF STUDY

Prognosis study (retrospective) LEVEL OF EVIDENCE: Level II.

Residency Program Reputation Influences the American Association of Hip and Knee Surgeons Match Results

BACKGROUND

No data evaluate the impact that an applicant's residency program reputation has on the outcome of the American Association of Hip and Knee Surgeons (AAHKS) fellowship match. This study sought to determine if an applicant's residency program ranking was associated with where the applicant matched on their rank list.

METHODS

We included all the US applicants from the "San Francisco Match" regarding AAHKS applicant data and match results from 2014 to 2018. Residency programs were divided into 5 tiers based on 2018 Doximity ranking of Orthopedic Residency Programs. Statistical analysis consisted of descriptive statistics, chi-squared tests, and analysis of variance.

RESULTS

In total, 656 applicants met inclusion criteria (620 males; 36 females). Tier 1 applicants applied to an average of 10 fewer programs than applicants from all other tiers. Eighteen percent of applicants from tier 1 residencies were offered interviews at 80%+ of their applied programs compared to 5% or less of the applicants from all other tiers. Applicants from top tier residencies matched at a significantly higher place on their rank list than other tiers (P < .05) and ranked into one of their first 2 choices 72% of the time. The mean fellowship rank position for tier 1 applicants was 5.96 compared to 7.04, 7.85, 7.78, and 8.10 for subsequent tiers, respectively (P < .05).

CONCLUSION

The fellowship match process represents a high-stakes and expensive process. This study found that applicants from more prestigious residency programs apply to fewer programs, gain more interviews, and match higher on their rank list than applicants from other residency programs.

How the Reputation of Orthopaedic Residency Programs Is Associated with Orthopaedic Fellowship Match Results

BACKGROUND

The primary goal of the present study was to determine if applicants from higher-ranking U.S. orthopaedic surgery residency programs match at a more desired position on their fellowship match-rank list compared with those applicants from lower-ranked residency programs.

METHODS

San Francisco Match provided results regarding applicant data and match results from 2014 to 2018 for all orthopaedic subspecialties except the hand and the shoulder and elbow. Unmatched applicants and international medical graduates were excluded. Residency programs were divided into 5 tiers (with tier 1 being the highest-ranked residency programs and tier 5 being the lowest-ranked programs) on the basis of 2018 Doximity rankings of orthopaedic residency programs. Statistical analysis consisted of descriptive statistics, chi-square tests, and analysis of variance.

RESULTS

Two thousand eight hundred and eleven applicants met inclusion criteria. Applicants from residency programs in tiers 1 and 2 applied to significantly fewer programs than those from tiers 3, 4, or 5 (p < 0.0001). Applicants from each tier were significantly more likely to attain interviews than applicants from all tiers below them (p < 0.01). Applicants from tier-1 residency programs matched at a significantly higher position on their rank list (p < 0.001) and were more desirably ranked by fellowship programs (p = 0.003) compared with all other tiers.

CONCLUSIONS

Applicants from the highest-ranking residency programs apply to fewer programs, interview at a greater percentage of these programs, and are more likely to match to 1 of their top-ranking programs than applicants from lower-ranking programs. However, the association of the applicant match position with the program ranking appears to be most pronounced when it comes to fellowships selecting which applicants to interview. These findings may help future applicants when determining which programs to apply to during the match.

Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors

BACKGROUND

The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions.

METHODS

We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1.

RESULTS

Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65-4.38] vs. 3.53 [95% CI 3.28-3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13-97.80] vs. 83.04 [95% CI 80.85-85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25-99.31] vs. 88.90 [95% CI 86.23-91.57], p = 0.004) scores were better among patients treated by surgical oncologists.

CONCLUSIONS

Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.

Normalized Competitive Index: Analyzing Trends in Surgical Fellowship Training Over the Past Decade (2009-2018)

OBJECTIVE

There is a lack of literature describing how competitive surgical fellowships are, especially across specialties. Such information would be valuable to prospective candidates, especially as immediate postresidency subspecialty training becomes the norm for general surgery. Match-rates alone may be misleading indicators as programs may not fill positions with unqualified applicants. We propose a simple metric to analyze the competitiveness of various surgical subspecialties to each other and themselves over time.

DESIGN

Retrospective cohort study. The Competitive Index is defined as the percentage of filled programs within each specialty divided by the match-rate for that specialty. For ease of comparison, a Normalized Competitive Index (NCI) was developed, normalizing the metric for all specialties in that year to a value of 1.

SETTING

The National Resident Matching Program, The Fellowship Council, and the San Francisco Match publicly available match data from 2009 to 2018.

PARTICIPANTS

General Surgery Associated Fellowship Applicants (Abdominal Transplant, Colorectal, Surgical Oncology, Minimally Invasive Surgery, Pediatric, Plastic, Critical Care, Thoracic, and Vascular).

RESULTS

The overall match rate for all specialties was 74.6% and 84.0% of all programs were filled. Over the past decade, pediatric surgery was significantly more competitive than other specialties (NCI 1.67, p < 0.0001), while surgical critical care (NCI 0.58, p < 0.0001) and vascular (NCI 0.90, p < 0.0492) were significantly less competitive. When comparing the NCI within each specialty from the first 5 years (2009-2013) to the last 5 years, (2014-2018), surgical critical care (NCI 0.54 vs. 0.62, p = 0.0462) and thoracic (NCI 0.74 vs. 1.08, p=0.0025) became significantly more competitive, while transplant (NCI 1.10 vs. 0.92, p = 0.0343) and colorectal (NCI 1.32 vs. 1.09, p = 0.0021) became significantly less competitive.

CONCLUSION

The NCI is a metric which might be useful to prospective applicants and which could be provided annually by organizations sponsoring fellowship matching processes. Further research must be performed to establish what defines a qualified applicant in each specialty.

A Survey of the Complex General Surgical Oncology Fellowship Programs Regarding Applicant Selection and Rank

BACKGROUND

There is significant demand for training in Complex General Surgical Oncology (CGSO) fellowships. Previous work has explored objective quantitative metrics of applicants that matriculated to CGSO fellowships; however, ambiguity remains concerning academic benchmarks and qualitative factors that impact matriculation.

STUDY DESIGN

A web-based survey was sent to each ACGME/SSO-approved CGSO fellowship training program. The survey was comprised of 24 questions in various forms, including dichotomous, ranked, and five-point Likert scale questions.

RESULTS

Twenty-nine of 30 program directors (97%) submitted complete survey responses, representing 64 of the 65 CGSO fellowship positions (99%) currently offered. Programs received a mean of 73 applications per cycle (range 50-125) and granted a mean of 26 interviews (range 2-45). Seventy-two percent of programs had an established benchmark for ABSITE score percentile before offering a candidate an interview, with 62% of those programs setting that benchmark above the 50^th percentile. The majority of programs also had established benchmarks for quantity of first author publications (mean: 2.3) and all publications of any authorship (mean: 4.4). An applicant's interview was ranked as the most important factor in determining inclusion on the program's rank list. The ability to work as part of a team, interpersonal interaction/communication abilities, and operative skills were rated as most important applicant characteristics, whereas an applicant's personal statement was ranked as least important.

CONCLUSIONS

After established academic benchmarks have been met, a multitude of factors influences ranking of applicants to the CGSO fellowship, most of which are assessed at the interview.

Survey of Surgical Oncology Fellowship Graduates 2005-2016: Insight into Initial Practice

BACKGROUND

Despite burgeoning interest in Complex General Surgical Oncology (CGSO) fellowship training, little is reported about postgraduate employment. The goal of this study was to characterize CGSO graduates' first employment and to identify factors that influenced this decision.

METHODS

The National Cancer Institute (NCI) and Society of Surgical Oncology developed and distributed an electronic survey to CGSO fellows who graduated from 2005 to 2016.

RESULTS

The survey response rate was 47% (237/509). Fifty-seven percent of respondents were first employed as faculty surgeons at a university-based/affiliated hospital, with 15% returning to their residency institution. The distribution of respondents' current employment across the United States mirrored the locations of their hometowns. Eighty-five percent of respondents care for patients across at least three disease types, most commonly hepatopancreatobiliary (81%), esophagus/gastric (75%), and sarcoma (74%). Twenty-seven percent of respondents spend the majority of their time in one area of surgical oncology; melanoma, breast, and head/neck were the most common. Two-thirds of respondents (67%) reported that they performed either clinical or basic science research as part of their current position. Multiple factors influenced the decision of first faculty position.

CONCLUSIONS

Most CGSO graduates are employed at academic medical centers across the country in proximity to NCI-designated centers, treat a variety of disease types, and spend a percentage of their time dedicated to clinical research.